Calling a spade
Business World, 15 August 2012


I was really taken aback when I heard the latest attack against artificial contraceptives (AC) — that they cause congenital anomalies in babies born of mothers who were on the ACs either before or during pregnancy. Senator Tito Sotto, and a little less conspicuously, former Governor and Congressman Ace Barbers, leveled these charges, citing their own experiences.

Tito Sotto said that his first-born and only son died 37 years ago, only five months after birth, of a congenital heart ailment, caused, he believes, by his wife having been on oral contraceptives (OC) when she became pregnant.

Ace Barbers recounted that his wife was also on birth control pills when she became pregnant 20 years ago with their first child Robert Lance, who died four months after he was born “weak” (“frail” was the other term used), and struggled through Sudden Infant Death Syndrome during that period.

Both of them “believe” that their sons’ ailments and subsequent deaths were caused by the OCs that their wives took, Sotto saying that Dr. Carmen Enverga Santos, the attending obstetrician-gynecologist, offered this as an explanation for the congenital anomalies and subsequent death of his son.

Dr. Enverga Santos is no longer around to either dispute or verify the explanation attributed to her. But perhaps the unidentified OB-GYN who attended the birth of Robert Lance Barber, is still alive, and can be asked to either dispute or verify Ace’s “belief.”

But — no disrespect intended with regard to Ace — it must be pointed out that a baby does not struggle with Sudden Infant Death Syndrome or SIDS for four months. As the name implies, death is sudden and without warning or symptoms. It is also noteworthy that many factors have been linked to a baby’s increased risk of SIDS — but the mother’s taking OC is not one of the 12 factors usually cited.

In any case, what the testimonies of Sotto and Barbers seem to imply is that if OC does not kill babies before birth (abortifacient), it will kill babies after birth anyway. Which is undeniably a new twist or turn in the RH controversy. The question before us, therefore is: Is there any medical/scientific basis to the “belief” of Sotto and Barbers?

To try to get to the bottom of this, I first called up the OB-GYNs that I know to find out what their experiences were. This is admittedly a very unscientific method, but since I was faced with two anecdotes, I wanted to start with anecdotal evidence from practitioners.

But I go ahead of my story. Before I called up the obstetricians, I also called up medical doctors whose opinions I hold in the highest regard. I called up Espie Cabral (former Social Welfare and Health Secretary ), not knowing that she was already at the center of the controversy. It turns out that she was at the Senate when Sotto made his speech, and as we all know, the lady was less than impressed — not by Sotto’s grief, but by his reasoning.

Dr. Cabral was her usual forthright self: Sotto (and I am sure she would say the same thing of Ace) committed a common logical fallacy: the so-called post hoc ergo proper hoc fallacy (after this, therefore because of this). And how does she know that Sotto’s reasoning was fallacious? Because there is no scientific evidence of any relationship between OC and congenital anomalies.

I also called up Dr. Camellia Posoncuy (the first Filipina neurosurgeon) who said that congenital anomalies are multifactorial, and it would be very difficult to specify a single factor as being the cause of the anomaly. Camellia was not aware of any study linking OC to congenital anomalies.

Then of course I texted (he was not answering his phone) my own OB-GYN, Jose Baens, a magna cum laude from UP College of Medicine, and from Johns Hopkins University in the United States. His reply: “From my private practice, and from the thousands of babies I delivered during my 38 years at PGH, we have observed no such correlation.”

And lastly I called up my current OB-GYN (Joe Baens is retired), China Reyes (professional name: Dr. Carmen Castillo), who said that not only she, but the colleagues in her Facebook network, were appalled at the inaccuracies (her language was stronger) that were being passed on as “truth” and “belief.” She, too, was unaware of any study that showed a linkage between contraceptive intake and fatal birth defects.

Okay, so much for the he-says-she-says stuff. So now I googled “oral contraceptives and congenital anomalies” (getting 179,000 results in 0.41 seconds).

I went through the abstracts of quite a number (obviously not 179,000). And the gist was very simple: No association, no correlation between contraceptives and congenital anomalies.

Some findings:

• From Waller, DK, et al, “Use of Oral Contraceptives in Pregnancy and Major Structureal Birth Defects in Offspring,” Epidemiology 2010 March: “Overall, our findings are consistent with the majority of previous studies that found women who use OCs during early pregnancy have no increased risk for most types of major congenital malformations.”

From Bracken, MB, “Oral Contraception and Congenital Malformations in Offspring,” ObstetGynecol 1990 Sept., “This lack of an association between OCs and birth defects in prospective studies agrees with the results of most of the better-designed case-control studies.” Bracken was at the time with the Yale University Perinatal Epidemiology Unit.

A Thai study cited by Phillips and Simpson in their “Contraception and Congenital Malformation” might be of particular interest to Senator Sotto: 8,816 births were studied, comparing the incidence of cardiovascular anomalies among several groups: users of OCs either before conception or during gestation (n=3038); injectable contraceptives (n=1229) and non-contraceptors (n=4023). Results: “no significant differences were found among the groups. Interestingly, the incidence of anomalies among OC users was lower than in the general population.”

Phillips and Simpson summarized the issue thus: “Allegations that inadvertent pregnancies occurring in users of contraception are associated with congenital anomalies are common. Fortunately, in virtually all instances, there is little to no scientific basis for such claims.”

There may be one notable exception: A study conducted in Britain between January 1974 and 1976 involving 10,479 infants born to users of OCs and nonusers showed that there were “significantly more infants with neural tube defects among users compared with non-users.” On the other hand,the same study showed there were no significant differences when it came other abnormalities, including cardiovascular systems (Kasan, “Oral Contraception and Congenital Abnormalities” BJOG: An International Journal of Obstetrics and Gynaecology). I wonder how the experts will explain that.

In any case, based on the above, Helen Gamboa Sotto, and hopefully her husband, can be comforted: after 37 years, they can be sure that they are not to blame (nor the contraceptives Helen took) for the congenital heart defect and death of their son.